1 / 41

1986-1987

1986-1987. Mini Pathria Michael Zlatkin Richard (Rick) G Stiles. Mini Pathria. Middle-aged male Hx of recent knee trauma. Case 1. Middle-aged male Hx of recent knee trauma. Radiographs. Sagittal. Coronal. Axial. Thigh. Differential diagnosis. Neurofibromatosis

zoltan
Download Presentation

1986-1987

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 1986-1987 • Mini Pathria • Michael Zlatkin • Richard (Rick) G Stiles

  2. Mini Pathria • Middle-aged male • Hx of recent knee trauma

  3. Case 1 • Middle-aged male • Hx of recent knee trauma

  4. Radiographs

  5. Sagittal

  6. Coronal

  7. Axial

  8. Thigh

  9. Differential diagnosis • Neurofibromatosis • Melorheostosis with soft tissue component

  10. Neurofibromatosis • Further history obtained • Skin nodules • Neurofibromas on cranial CT 7 years previously (not acoustic neuroma)

  11. Case 2 • Middle-aged female with thigh mass

  12. Radiographs

  13. Coronal

  14. MR

  15. Follow-up • Mass biopsied, benign plexiform neurofibroma • Patient developed hip pain

  16. Hip MR

  17. Neurofibromatosis • Plexiform neurofibroma at biopsy • No evidence of malignancy

  18. Case 3 • 40 year old male with slowly growing painless mass

  19. Plexiform neurofibroma

  20. Plexiform neurofibroma • Specific finding for NF1 (peripheral form) • 5% of patients with NF1 • Approximately 5-10% degenerate to neurosarcoma courtesy of Mark Murphey, AFIP

  21. Neurofibroma • Localized • Diffuse • Plexiform • Well-defined • Bag of worms • Infiltrating

  22. Elephantiasis neurofibromatosa • Diffuse form of plexiform neurofibroma • Overgrowth of epidermal and subcutaneous tissue • Wrinkled and pendulous appearance

  23. Michael B. Zlatkin and Alfredo Arraut NMSI • 27 year old male involved in a motor vehicle accident

  24. 27 year old male involved in a motor vehicle accident

  25. 27 year old male involved in a motor vehicle accident

  26. Findings • Subscapularis tendon is avulsed with bone from the lesser tuberosity • Humeral avulsion of the anterior band of the glenohumeral ligament (HAGL) • Middle glenohumeral ligament and possibly the superior glenohumral ligament may be avulsed as well • Possible reverse Hill-Sachs lesion

  27. Subscap Rupture and HAGL (BHAGL) • Rupture of the subscapularis tendon uncommon but can be seen in younger patients injured by forced external rotation or extension of a partially abducted arm • Tears occur near insertion on the lesser tub. May occur at sup margin, where tendon may be weakened by degeneration • Avulsion fracture of the lesser tuberosity may occur, and is displaced medially and inferiorly • Subscapularis avulsions are also associated with injury to the anterior capsule and glenohumeral ligaments (HAGL) • When the AIGHL avulses a fragment of bone from the humerus, the lesion is known as a bony HAGL, or BHAGL • ? With MGHL and SGHL torn = Super BHAGL

  28. Michael B. Zlatkin and Alfredo Arraut NMSI • 17 year old male with bony growth on the dorsum of hand

  29. 17 year old male with bony growth on the dorsum of hand

  30. 17 year old male with bony growth on the dorsum of hand

  31. Findings • Bone prominence on the dorsum of the hand between the trapezoid, capitate, and bases of the 2nd and 3rd metacarpals • Associated with base of 3rd metacarpal, but no marrow continuity with it • Sclerosis and cystic change at junction with 3rd metacarpal base

  32. Carpal Boss • Bone protuberance on dorsum of the hand • Degenerative osteophyte or os styloideum • Located between trapezoid, capitate, and base of 2nd and 3rd metacarpals • Most often fused to a metacarpal base, but rarely (2%) can be completely isolated • Symptoms caused by degeneration, formation of ganglion or bursa, or snapping of an extensor tendon moving over it

  33. Carpal Boss • Can be demonstrated on lateral radiograph with hand flexed and supinated 30-40 degrees; best seen with mild ulnar deviation • Alternatively can image with CT or MR • MR can demonstrate marrow edema in the carpal boss and surrounding soft tissue changes

  34. Carpal Boss – Companion Case Carpal boss fused to base of third metacarpal with edema in overlying soft tissues

  35. Carpal Boss - Companion Case Carpal boss fused to third metacarpal with fracture at its base

  36. Carpal Boss – Companion Case Surface rendering of carpal boss with fracture at its base

  37. Michael B. Zlatkin and Alfredo Arraut NMSI • 33 year old professional hockey player with pain in the flank after practice

  38. 33 year old professional hockey player with pain in the flank after practice

  39. 33 year old professional hockey player with pain in the flank after practice

  40. Findings • Partial thickness tear of the internal oblique muscle belly proximally, with surrounding edema and hematoma • Fluid tracking between internal and external obliques • Feathery pattern of edema at the more distal aspect of the internal oblique

  41. Side Strain • Uncommon sporting injury presenting with pain and tenderness over anterolateral and posterolateral lower ribcage • Associated with cricket, golf, and ice hockey – eccentric contraction of trunk muscles • Partial or complete tear of lateral abdominal wall musculature (internal oblique > external oblique > transversus abdominis) • May also see avulsion at the muscular origins from the lower ribs • Recovery takes 6-10 weeks. Full recovery is the norm

More Related